Study finds religion shapes views of terminal sedation

While the U.S. Supreme Court does not object to a medical practice that places a higher priority on alleviating pain than maintaining a patient’s life, whether individual doctors do can vary by their religion, according to a recent study.

Terminal sedation may be confused with physician-assisted suicide, which is illegal in every state except Oregon, but a 1997 Supreme Court ruling decreed the practice is permissible, making it an alternative to physician-assisted suicide. Dr. Lauris Kaldjian DIV ’94, a current member of the University of Iowa Medical School faculty, led a research effort measuring the attitude of physicians and medical residents toward terminal sedation while teaching at the Yale School of Medicine. He found religious beliefs play a major role in shaping a doctor’s opinion of the practice.

Whereas assisted suicide is performed with the intent of killing the terminally ill patient, terminal sedation uses strong analgesics and sedatives to alleviate pain and other symptoms without the intention of killing the patient, although the result may be death. A terminally ill patient is expected to live six months or less and suffers from ailments such as end stage renal failure, cardiac failure, cancer or AIDS.

“In the matter of terminal sedation, you as a physician must acknowledge the risk and probability of death is something to consider anytime high doses of analgesics or sedatives are used,” Kaldjian said.

He said analgesics such as morphine and sedatives like valium are typical treatments for pain relief used for terminal sedation. According to Kaldjian’s study, 96 percent of physicians interviewed agreed with the use of morphine for pain relief, but only 78 percent of the physicians would employ morphine for terminal sedation. Only one-third of the physicians agreed with the practice of assisted suicide.

“Picture it like a staircase where you have to add something at each step, and where less and less people agree at each step,” Kaldjian said. “So most of the people will agree with the use of the medications, but then fewer agree with using them on terminally ill patients, and even fewer to hasten their death.”

The results also revealed that physician-assisted suicide was largely unacceptable to Catholic doctors, while it was acceptable to Unitarian and Jewish physicians, said Dr. Thomas Duffy, Kaldjian’s former colleague and a professor at the Yale School of Medicine. He said other Christian denominations were in between the two camps.

The Medical School does not have a concrete terminal sedation education policy for future physicians, but rather leaves the decision to the individual’s logic and compassion, Yale School of Medicine Dean Robert Alpern said.

“The most important thing for doctors to do is to make [patients] comfortable and alleviate pain, but the approach that most doctors take is based on common sense,” Alpern said.

Duffy said there is still more research to be done before any real conclusions can be drawn. While the current study provides trends, he said more physicians need to be interviewed to produce meaningful statistics.